Downtime Reporting Success Story

" This report is outstanding! It does everything we needed it to do!"

Renee Johnson Nursing Application Coordinator

Company Overview

St. Mary's Hospital in Amsterdam, New York, a member of Ascension Healthcare, is the largest acute care hospital in the region. St. Mary's provides a full range of services designed to fulfill the total healthcare needs of the community, while being the lowest cost provider.

Business Challenge

St. Mary's Hospital was planning to implement MEDITECH's electronic medication administration record software (eMAR) for the majority of inpatient and outpatient Units at their hospital. A transition to eMAR meant that paper charts documenting patient medications scheduled to be administered, or already administered, would no longer be available should the MEDITECH Healthcare Information System (HCIS) become unavailable due to planned or unplanned downtime. A methodology for insuring a backup copy of medication administration record (MAR) was readily available during downtime was deemed essential to implementation of the eMAR. Among criteria established by the hospital's steering committee was that the backup MAR must:

Contain MAR information that is no more than 15 minutes out of date

Be available to print from each Unit if power, network, and/or MEDITECH applications were unavailable

Be formatted such that the report could be entered into a patient's permanent medical record if necessary

Solution

Initially, the MEDITECH NPR report writer was considered for use in generating the downtime MAR report. While perfectly capable of gathering the required MAR data, NPR proved inadequately suited to generate the backup MAR report in the 15 minute interval as dictated by the design requirements. Acmeware proposed that the MEDITECH Data Repository running in ³continuous update² mode be considered as a potential alternative source to generate the backup MAR report.

The first issue that needed to be addressed was confirming that the DR continuous update process actually transferred all MAR application data into the DR in a timely manner. To accomplish this, Acmeware developed code that monitored the time-lag from when data was entered in live applications to when the data appeared in the DR. For this effort, we focused only on the DR tables that contained data used in the MAR. Over a six week period, it was determined that the data in the DR rarely fell more than 3 minutes behind the underlying application. These findings provided the impetus to move forward with the DR-based backup MAR solution.

Acmeware initially developed a series of SQL Server Transact-SQL Stored Procedures to perform MAR data extracts from the convoluted DR tables. The extracted data was restructured into a normalized format and filed to an Acmeware designed MAR data mart. Data from Admissions, Medical Records, Pharmacy, and Nursing applications was included in the generation of the MAR data mart. A SQL Job was created to run on a regular basis and keep the data mart current.

SQL Server Reporting Services (SRS) , a report generation, deployment, and management application that is included as part of the DR's SQL Server 2000 database, was chosen as the tool to render and deploy the backup MAR reports. Medications in each Unit report were organized by patient. Report page-numbering was initialized with each new patient allowing one's backup MAR report to be separated from the entire Unit report and entered into his/her permanent medical record. Space on each report was also allocated for medication documentations that occurred during downtime. SRS also allowed a single report design to be used to render all eleven Nursing Unit reports, simplifying development and support costs. Each report was rendered in Adobe Acrobat format and pushed to a specific PC located at each Nursing Unit. SRS Subscriptions were used to schedule each Unit MAR report to run on a 15 minute cycle, 24 hours a day. Nursing Unit PCs, along with a serially connected printer, were plugged into a "red outlet" thus insuring that reports could be printed even when line-power was unavailable. This configuration also allows the backup MAR report to be available for printing and distribution when planned or unplanned downtime occurred in the MEDITECH application or the hospital network. Finally, a validation routine was developed to notify IT staff by email if a Unit's backup MAR report ever fell more than 30 minutes out of date.

Conclusion

St. Mary's Hospital confronted a report development and deployment problem where design constraints made traditional use of an NPR Report Writer solution inadequate. MEDITECH's recent efforts in insuring the DR is updated in a continuous manner, Acmeware's efficient generation of a MAR data mart, and SQL Server Reporting Services report generation and deployment capabilities offered an innovative solution. Since this project went live, the same concept has been implemented at several other eMAR sites that have the DR module. Versions now exist in SRS 2005 as well as in Business Objects Crystal Report.